A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

Abstract

-Context -Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. Objective -To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. Methods -One hundred fiftyfive patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. Results -Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. ConclusionsThe use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.

High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group

“…Gomes et al . confirmed our suspicion in his study: not all small inflammatory lesions visualized by modern technology are necessarily indicative of reflux . Several other studies confirm this thesis.…”

Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology

“…The use of FICE improves the ability to diagnose minimal lesions of non-erosive reflux diseases at the esophagogastric junction. 30,31 The diagnosis of endoscopic Barrett's esophagus has been under discussion for the past decade because palisade vessels may be obscured by inflammation, or the location of the upper end of gastric folds may be diversely changed. Palisade vessels are more clearly visualized in Barrett's mucosa using FICE than with WLI.…”

Seeing more is seeing better

“…In the article by Gomes Jr. et al (1) , the presence of esophageal MEL lesions did not predict the presence of reflux symptoms. This absence of correlation happened also with the presence of MEL lesions and age (under or over 40), the use of NSAIDs, alcohol and tobacco abuse, and use of PPI.…”

“…As in any new technique or technology the length of the learning curve and the reproducibility of the results must be carefully evaluated before their incorporation in daily practice. In the article by Gomes Jr. et al (1) , two examiners presented lower performances in detecting esophageal MEL lesion with white light and FICE when compared to the remaining three examiners. The examiner's previous experience and training with the FICE technology is unknown and might have influenced the results.…”

“…In this issue of the ARQUIVOS de GASTROENTEROLOGIA, Gomes Jr. et al (1) describe the capability of one method of virtual chromoendoscopy -FICE (Fuji Intelligent Collor Enhancement) -to detect minimal endoscopic lesions (MEL) in patients referred to upper gastrointestinal endoscopy for different reasons including heartburn. Patients with obvious findings of reflux esophagitis, moniliasis, varices and esophagectomy were excluded from the trial.…”